Healthcare Provider Details

I. General information

NPI: 1003315102
Provider Name (Legal Business Name): MADELINE MALDONADO, LCSW CONSULTING P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 MIDLAND AVENUE APT 10G
BRONXVILLE NY
10708-6428
US

IV. Provider business mailing address

1160 MIDLAND AVENUE APT 10G
BRONXVILLE NY
10708-6428
US

V. Phone/Fax

Practice location:
  • Phone: 917-880-8193
  • Fax: 914-346-5031
Mailing address:
  • Phone: 917-880-8193
  • Fax: 914-346-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR062204-1
License Number StateNY

VIII. Authorized Official

Name: MS. MADELINE MALDONADO
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSWR
Phone: 917-880-8193